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Clin Med 3 GI > Diverticulitis/CRC > Flashcards

Diverticulitis/CRC Flashcards

0
Q

site of most diverticulosis

A

sigmoid colon

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1
Q

tx diverticulosis

A

high fiber diet (25-40 g/day)

adequate fluids

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2
Q

complication of macroperf in diverticulitis

A

free air, peritonitis

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3
Q

complications of diverticulitis (4)

A

abscess- walled off perforation
fistula- to the bladder or vagina
obstruction- due to inflammation
perforation

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4
Q

progressive, steady/aching LLQ pain, fever, tachycardia (from pain)
N/V, constipation, diarrhea, urinary sx

A

complicated diverticulitis

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5
Q

rigid abd with guarding, rebound tenderness, & absent bowel sounds

A

peritonitis

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6
Q

lab findings for diverticulitis? (3)

A

CBC- leukocytosis w/ left shift
stool for fecal occult
DRE for rectal mass

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7
Q

test of choice for diverticulitis dx?

A

CT scan

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8
Q

CT findings for diverticulitis (4)

A

fat stranding
bowel wall thickening
diverticulosis
the 4 complications (abscess, fistula, obst., perf)

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9
Q

flex sig/colonoscopy/BE use in diverticulitis?

A

contraindicated in acute diverticulitis due to perf. risk

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10
Q

tx uncomplicated diverticulitis (4)

A

metronidazole 500 mg PO TID
Cipro 500 mg PO BID 10-14 days both
clear liquid diet 2-3 days
colonoscopy 4-6 wks after episode

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11
Q

indications for hospitalization with diverticulitis (4)

A

toxic appearance
inability for PO
comorbidities (elderly, immunocomp.)
complication

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12
Q

inpt tx diverticulitis (4)

A

NPO (1-2 days)
IV fluids
Demerol
IV abx w/ G- and anaerobic coverage

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13
Q

indications for inpt emergent surgery for diverticulitis

A

peritonitis

failure to improve w/in 3-4 days

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14
Q

most common cause of acute lower GI bleed in the U.S.

A

diverticular bleeding

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15
Q

sx of diverticular bleeding (3)

A

painless bleeding
occult blood
hematochezia

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16
Q

pathology & common site of diverticular bleeding

A

artery is draped over length of diverticulum which is easily exposed to injury

usually Right side

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17
Q

diagnostics for diverticular bleeding (2)

A

1st: EGD/NG to r/o UGI source
2nd: Flex Sig or Colonoscopy
locate the source of the bleeding

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18
Q

non-neoplastic, benign colon polyps

A

hyperplastic

19
Q

non-neoplastic, inflammatory colon polyps

A

psuedopolyps

20
Q

neoplastic colon polyps

21
Q

most common adenoma

A

tubular adenoma

22
Q

highest cancer risk adenoma

A

villous adenoma

23
Q

high risk adenoma characteristics (3)

A

> 10 mm
high grade dysplasia on pathology
villous component

24
Q

follow up for 1-2 small adenomas?

25
Q

indications for follow up on adenomas w/in 3 years?

A

10+ adenomas

26
Q

f/u for large adenoma or one that had to be removed in pieces

27
Q

common site of CRC

28
Q

risk factors for CRC (many)

A

personal or FH adenoma, colon CA, FAP/HNPCC
Age > 50
IBD (colitis longer than 8-10 years)
obesity, excess EtOH, smoking, Type II DM, AA

29
Q

asymptomatic; or: abd pain, change in bowel habits, hematochezia or fecal occult, weakness/fatigue, anorexia, wt. loss, iron deficiency anemia

A

colorectal cancer

30
Q

PE: physical wasting, wt. loss, signs of volume loss, pallor, LAD, abd distension, ascites, mass, organomegaly, + fecal occult, rectal mass

A

colorectal cancer

31
Q

classic imaging finding of CRC

A

apple core lesion

32
Q

lab findings for CRC (4)

A

microcytic anemia
elevated alk phos
apple core lesion on CT
carcinoembryogenic antigen (CEA) for monitoring reoccurrence

33
Q

stage A CRC on Dukes-Astler-Coller

A

negative nodes, confined to mucosa

34
Q

Stage C1 of Dukes-Astler-Coller

A

positive nodes, extension through the muscularis propria

35
Q

CRC screening (3)

A

Colonscopy- best choice
Combo Flex Sig & BE- if you have to
Fecal immunochemical test- preferred CRC detection test

36
Q

when to begin CRC screening?

A

50 y/o, w/o risk factors

37
Q

familial adenomatous polyps (FAP) etiology

A

autosomal dominant, APC mutation

38
Q

indications for prophylactic colectomy in FAP (2)

A

> 1 cm

villous pathology

39
Q

extracolonic manifestations of FAP (4)

A

osteomas
dental abn
adrenal masses
epidermoid cysts & fibromas

40
Q

early onset right-sided CRC (40-45 y/o)

41
Q

HNPCC colon CA common site

A

proximal right sided

42
Q

HNPCC associated CA (many)

A

ovary, gastric, small bowel, hepatobiliary, pancreas, renal pelvis, ureter

43
Q

HNPCC diagnostic criteria

A

3-2-1
CRC or other assoc. CA in 3 relatives
occurrence in 2 successive generations
Diag. by age 50 in at least 1 pt in hx

44
Q

HNPCC screening

A

annual colonscopy at 20-25 or 10 years prior to earliest age of onset in FH

Clin Med 3 GI (4 decks)

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